Physicians increasingly turning to non-opioid medications
- Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. • Between 8 and 12 percent develop an opioid use disorder. • An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.
- About 80 percent of people who use heroin first misused prescription opioids.
- Call 911 immediately.
- Administer naloxone, if available.
- Try to keep the person awake and breathing.
- Lay the person on their side to prevent choking.
- Stay with him or her until emergency workers arrive.
Opioid overdose deaths in the United States have quadrupled since 2000
Written By Lauren Glendenning
Brought to you by Kaiser Permanente
As the United States grapples with an opioid epidemic that has spawned a public health crisis, countless physicians around the country are trying to do their part in eliminating the potential for addiction.
Opioid overdose deaths in the United States have quadrupled since 2000, and drug overdose has become the leading cause of accidental death in the United States, according to the Centers for Disease Control and Prevention. It’s estimated that 91 Americans die every day after overdosing on opioids, which include illegal heroin as well as legal prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl and others.
When these opioids interact with receptors in the brain and nervous system, pleasurable effects and pain relief occur, according to the National Institute on Drug Abuse. That pleasure or pain relief acts like a reward for the brain, and those who suffer from addiction will pathologically pursue that reward or pain relief, according to the American Society of Addiction Medicine.
“Physicians need to really assess the need for opioid medications. Not all pain needs opioids for treatment,” said Dr. Jeannine Benson, Chief of Primary Care at Kaiser Permanente’s Edwards Medical Offices. “We need to talk with our patients about the risks/benefits of these medications and maintain a relationship that requires continued follow-up. Physicians need to identify at-risk patients and monitor use closely if it is decided that opioid medications are appropriate for treatment.”
Any opioid medication can be abused, and even short-term use can lead to addiction, Benson said. Patients who are most at risk of developing an addiction to these medications include those with current, untreated addiction or a previous history of addiction, patients with a history of drug diversion, patients with a history of untreated mental illness and patients who might display other red flags as noticed by physicians, she said.
“Patients taking opioid medications should be informed of the risks and benefits,” Benson said. “They should be worried about taking them as misuse can lead to very serious consequences.”
It’s up to physicians to communicate about a patient’s plan for pain management. A surgeon treating someone for postoperative pain should be in contact with the primary care provider to make sure everyone is on the same page, Benson said.
“There are resources out there to monitor use as well. For example, the Prescription Drug Monitoring Program through the state of Colorado tracks opioid prescriptions, so physicians can look for any opioid prescription that is prescribed in Colorado,” she said. “Other states have similar programs as well. Physicians should also readdress chronic pain with patients regularly.”
For patients suffering from chronic pain, physicians need to guide them toward lifestyle changes, as well as explore alternative therapies. Patients also need treatment for any mental illnesses, Benson said.
“Physicians also need to set the expectation for appropriate levels of pain control,” she said. “Fulfilling an expectation of complete resolution of chronic pain often leads to over-medication.”
Physicians at Kaiser Permanente try to incorporate alternative medications as much as possible. There are several other types of pain medications that are not dependency-causing, as well as many non-pharmacologic interventions that also can be helpful, said Dr. Carol Venable, Internal Medicine Physician with Kaiser Permanente’s Frisco Medical Offices.
“We have a team approach to pain management, and we make sure every member of our healthcare team is educated on how to help patients achieve successful pain control while minimizing the need for dependency causing medications,” Venable said. “We also spend a lot of time educating patients on risks and appropriate usage, as well as the ultimate goal of tapering off of the opioid medication.”
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